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History of present illness: A 15-year-old male was transported to the emergency department via ambulance as a trauma activation after being struck by an automobile while jogging. Patient was alert and oriented, with no focal neurological deficits and no loss of consciousness. The patient complained of right eye foreign body sensation. Significant findings: Physical exam was significant for multiple broken teeth, multiple minor abrasions on the face, and fine shards of shattered glass on his face and hair. His right eye had conjunctival injection, with no signs of subconjunctival hemorrhage or ocular penetration. Vision, extraocular movement, and pupillary exam were grossly intact. Fluorescein staining with slit lamp exam with cobalt blue filter examination of the right eye revealed superficial bulbar conjunctival uptake of fluorescein dye staining an area of the conjunctiva inferior to the limbus 5 mm vertical by 2 mm horizontal (estimation by photo provided). No foreign bodies were visualized in the inferior fornix. These findings were consistent with superficial conjunctival abrasion. The exam noted sparing of the corneal epithelium. Discussion: The conjunctiva is a thin, transparent membrane covering the ocular surface from the corneal limbus to the posterior eyelid margin.1 When damaged, the patient will classically have a “foreign body” sensation. It is important to identify the extent of the injury as not extending over the cornea, and also to search for lodged foreign bodies that damage the conjunctiva further with each blink. Classically retained foreign bodies will form a linear and vertical pattern of staining with fluorescein.2,3 Fluorescein stains expose basement membrane and fluoresces bright green under ultraviolet light, thus indicating areas of damage in contrast to its surrounding tissue.4,5 In the setting of acute trauma, urgent Ophthalmologic consultation is indicated if there is anterior chamber hemorrhage, a ruptured or perforated globe, or conjunctival laceration greater than 1cm.6 Most minor mechanical traumas to the conjunctiva have an excellent prognosis and can be handled in the emergency department with outpatient treatment with antibiotic drops or ointment.

History of present illness: A 49-year-old male presented with a chief complaint of left hand pain after a stingray sting. The patient reported that he was swimming in the ocean in Huntington Beach, California, approximately two hours prior to arrival when a stingray stung him on his left hand. The pain was severe, constant, worse with palpation and was associated with hand numbness. Significant findings: Physical exam revealed a 3cm laceration to the ulnar side of the dorsum of the left hand with minimal hand swelling. There was no exposed tendon or bone, the hand was neurovascularly intact and had full strength. A small barb was visualized and removed from the injury site. Radiograph of the left hand confirmed that there was no remaining barb (see normal x-ray). Discussion: Stingrays are bottom-dwelling fish with a flat body and a tail with barbed stingers with 2 venom-containing grooves. They are normally not aggressive towards humans; however, when frightened, they can reflexively sting in self-defense. Stingray stings account for thousands of injuries each year.1 These envenomations are very painful, yet are uncommonly associated with systemic symptoms. The puncture wounds often have retained foreign bodies from the spine, range from superficial to deep, and are frequently contaminated.1 Workup commonly includes imaging to evaluate for retained barbs. Treatment includes submerging the wound in hot water for 90 minutes, copious irrigation, removal of barbs if present, tetanus booster and commonly antibiotics to cover for skin flora/vibrio species.2 The venom contains amino acids and toxic fractions including phosphodiesterases, 5′-nucleotidases, and serotonin. Once deposited into the wound and exposed to heat, the venom deteriorates rapidly, as it is highly unstable and very heat labile.3 Prognosis is good, with rare complications including infection, and healing can be expected within 1-2 weeks.4 For this patient, the hand was soaked in hot water, which improved the patient’s pain. The wound was irrigated. The patient received a tetanus booster and was discharged home on Doxycycline and Keflex.